Sandy Scott

From Broken Neck to Broken Records

Another bad approach to the treatment of prostate cancer

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I have often written about the subject of prostate cancer in that I watched my grandfather die of the disease 3 months after diagnosis. Here is another bad therapy conjured up by the medical profession. One of the things that I have often discussed is the tack of active surveillance as opposed to more radical treatment(s).

It’s called androgen deprivation therapy, ADT for short, and it works like this: drugs (and there are several that can be used) are administered, often by injection, to suppress testosterone production – lowering testosterone levels has been shown to slow the growth of prostate cancer cells. But wait. Now, from researchers at Tulane University, comes a study showing that for men with low-grade, slow-growing disease, ADT can do more harm than good. There are two reasons for that: 1) low-grade prostate cancer is unlikely to do much harm in and of itself; and 2) ADT can lead to several unpleasant health issues, including hot flashes, loss of libido, fracture risk, muscle loss, fatigue, depression, diabetic risk, erectile dysfunction and weight gain. OK, what should be done about low-grade cancer? The researchers have two words: “active surveillance.”

As an aside, I find it interesting that most men suffer from prostate cancer at a time in their lives when their testosterone levels are low as opposed to when testosterone is coursing through their veins. Some in the medical profession argue that low testosterone rather than high testosterone is a possible risk factor for prostate cancer.

Health and Fitness Versus Performance Revisited

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Health and Fitness Versus Performance Revisted

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This is a follow-up to my last blog regarding the potential downside to excessive training.

With the news that one of my cycling acquaintances recently underwent 7 ½ hours of back surgery, and not so recently, the placement of an arterial stent to combat arterial blockage, I want to point out that this athlete with more than 50 years of racing experience, is not atypical of my observations. This is an incredibly common phenomenon with those who train in the extreme with the goal of excelling in sports competitions. Join the after-ride coffee chat of the local bike club someday and if it is anything like the local club, you could publish an issue of JAMA (Journal of the American Medical Association) just from the maladies of those gathered.

I have been through two major, multiple year, athletic training cycles as an adult – one led to three national running titles and the other led to a national cycling title and a national time trial record which still stands. I would say that in both instances, I was considerably healthier, and looked and felt better after I retired, and had been on a regimen of non-competitive type, fitness training. I am now about 11 months out from my retirement from bicycle racing. Physiologically, my cardiac system has undergone an interesting change. My erstwhile resting heart rate, which was in the low 40s, is now in the high 50s. Unfortunately, when it was in the low 40s, I could not get through one minute of feeling my pulse without experiencing numerous skipped/missed beats and I underwent occasional bouts of AFIB (atrial fibrillation) and atrial flutter. This culminated in spending 4 days in the cardiac ward a couple of days after winning cycling titles and kicking young butt at the Georgia Senior Olympics. I underwent two procedures under general anesthesia including an ablation procedure for atrial flutter. My heart no longer suffers these arrhythmias of extra/missed beats and I have not suffered an incident of AFIB since my retirement from “excessive” training and racing.

I have gained 12 pounds of muscle and I look, feel, and simply AM physiologically better than I was as a competitive athlete. My PSA level is the lowest it has been in many years. By the way, for you competitive athletes, I do get it. I was well aware of the phenomena of which I preach, but I was willing to pay the potential price to achieve my athletic goals. You should be aware of these potential downsides and also be willing to pay the potential price.

My current exercise regimen, which has me feeling better than ever, consists of 6 days a week of aerobic training utilizing either a bicycle outdoors, a spin bike in my home gym, or my NordiTrack cross-country ski machine. I still do sessions of interval training, which even for a non-competitor gives one the best bang for the buck in achieving optimal fitness. I do two days a week of weight training and do my heavy training day on the day that I skip an aerobics workout.

I believe that inflammation and arterial blockage are two of the biggest enemies of the body and I combat that through my “sensible” aerobic exercise and supplementation including the anti-inflammatory agent, ZyFlamend, l-arginine Complete for cardiac health and the taking of .81 mg of aspirin daily. You can find more information on supplementation by searching my past blogs.

We love to extol the virtues of those who complete multiple marathons and compete in Ironman events, but some of the later stories of these competitors are rather grim. I so recall my friend, teammate, national class athlete and record holder, renowned cardiologist and medical editor of “Runner’s World” magazine, Dr. George Sheehan, telling me, “We are probably immune from cancer because of the way we train.” Unfortunately, the good doctor is no longer with us having died from metastasized prostate cancer at my current age of 74. There are too many stories similar to George’s.

If you choose the path of extreme training for performance/competition rather than training for health and fitness, just be aware that you might join the legions of athletes that I am aware of that wound up sitting in the waiting room of oncologists, cardiologists, urologists and orthopedic surgeons.

I used the photograph of an owl for this piece for very specific reasons. The owl is said to be wise, and this particular owl is obviously trying to get your attention!

Sandy Scott
October 2014

Is It Possible To Exercise Too Much?

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I published this article under the title, “Do We Pay a Medical Price to be Elite Athletes?” on the Growing Bolder site prior to having my own blog site as a so-called Growing Bolder Elite Blogger. The message is so important, that I wanted to publish it here. The catalysts for publishing this article here are three-fold:

1) I was informed today that a very active competitive cyclist friend of mine suffered a heart attack while training on his bicycle.

2) A recent study showing that just 7 minutes of running a day halves one’s risk for heart disease. More information on that study is available here.

3) Since writing the original article, a friend of mine who was both a champion runner and cyclist died from metastasized prostate cancer.

Here is the original article:

Do We Pay a Medical Price to be Elite Athletes?

If you are a person who exercises regularly, you are undoubtedly aware of Dr. Kenneth Cooper, the founder of the Aerobics Center in Dallas, TX and the person who some believe started the exercise revolution in the 70s with his book “Aerobics.” Dr. Cooper has considerably changed his recommendations regarding exercise intensity over the years. He used to preach that more intensity equated to more fitness. He now recommends a regimen of walking as opposed to running in that he indicates that excessive exercise causes excessive free radical production in the body. It is those free radicals he proposes that is the cause of many medical issues including heart related issues and cancer.

In his book “The Antioxidant Revolution”, Dr. Cooper, MD emphasizes that excessive exercise is a major cause of oxidative stress. He became very concerned when he began seeing several of his super exercisers who had been coming to his aerobic center in Dallas dying from heart disease and cancer at an early age. Dr. Cooper points out that when we exercise excessively, the production of free radicals goes off the graph, or in other words it increases exponentially.

A good friend of mine and Dr. Cooper was Dr. George Sheehan, cardiologist, prolific author, world-class runner and the erstwhile medical editor of “Runner’s World” magazine. As an aside, one of the most enjoyable days I have ever experienced in competitive sports was at the Eastern Regional AAU track championships at Princeton University, circa 1980. George was my teammate on the Shore AC, and he wanted to break the American age-group (55-59) record for 1500 meters. In that I did an incredible amount of track interval work and had a built-in stop watch in my head from all of that work, the plan was that I would use the race as my warm-up for the 5000 meters (which I went on to win) and pace him to the record with his desired splits. He broke the record. I spoke with George via telephone frequently during his office hours in that he was always more than willing to chat if the subject was running.

One day during one of our conversations, he expressed the opinion that because of our athletic lifestyles, we were probably causing ourselves to be immune from cancer. I am about to argue to the contrary. Apparently his supposition was not terribly accurate – George died of metastatic prostate cancer and I had a prolonged battle with malignant melanoma about a dozen years ago. Fortunately, I won my battle. As a coincidental aside, it was Dr. Cooper who discovered Dr. Sheehan’s prostate cancer during a routine physical in Dallas. I have gone on however, to experience numerous other skin cancers including every form of it. I joke with my dermatologist that I am a poster boy for skin cancer. I also suffer from at least an annual bout of AFIB – atrial fibrillation – something quite common with aerobic athletes.

Having said all of the above, the catalyst for my writing of this piece is the extraordinary number of elite athletes that I personally know who are suffering from serious heart issues or dealing with metastatic cancers. Specifically, my encounter with one national champion triathlete the other day with the telltale large, rectangular hump under the skin of his chest indicative of a pacemaker. In addition to him, two Kona Ironman finishers that I know, one of whom is a world champion, both sport pace makers as they continue their participation in their chosen sport. Another world champion triathlete suffered from ventricle fibrillation (much more serious than AFIB) and underwent a medical ablation procedure to correct his problem.

Speaking of heart issues, one local, very successful, young bicycle racer died of heart failure during a recent bicycle training ride. My significant other’s husband, an athlete all of his life and a very active triathlete, died of cardiac arrest at the age of 55 during a formal swimming workout with the local triathlon club, The Mad Dogs. Another local champion cyclist was the recipient of a stent in one of his arteries to deal with his heart issues. AFIB (atrial fibrillation) is a common phenomenon among active aerobic sport oriented athletes.

Just in the past year, two of my associates, both nationally ranked cyclists and both state champions (in the 65-69 age group) have been diagnosed and treated surgically for metastatic prostate cancer. A third, a champion runner, is also fighting metastatic prostate cancer. All three are on Lupron, a medication that medically castrates the patient to rid the body of testosterone. All three continue to compete. At least three other avid local cyclists I know have been treated for prostate cancer.

Although my main concern is disease potentially caused by excessive exercise, I would be remiss if I overlooked the incredible number of ex very serious runners I know now sporting new hips and knees and the number of current serious cyclists I know with chronic back issues.

Back to my original question, do we pay a medical price to be elite athletes? Decide for yourself! If you are interested in the pursuit of health, a program of vigorous walking, good nutrition, sound supplementation and adequate sleep will serve you well. If you want to be an elite athlete, understand the potential risk/rewards.

Addendum: Understand that the above was written by a 73 year old inveterate athlete who is about to leave for a 3 1/2 hour cycling training ride in 90 degree heat with excessive humidity. Just as I knew that I had to save my life each of the 657 times I have jumped out of a an airplane, I have an insatiable need to kick competitive butt and I am more than willing to roll the dice to achieve that wonderful goal!

ADDENDUM – 9-24-13

Little did I know when I wrote this piece that I would become one of the prime examples of the phenomenon to which I alluded. One day I was kicking butt at the Georgia Golden Olympics turning in a time 20 seconds faster in the 5K time trial than was my time in the previous two years where I turned top time for all age groups. I mentioned in the above piece that I typically suffer one incidence of AFIB annually, and that AFIB had always stopped with no medical intervention typically within a few short hours.

The morning after two days of competition where I raced my heart out (pun intended), as I began to sip some OJ in the morning, my typical morning pulse of the mid to low 40s began racing at 134 beats per minute. By the end of the day, I had seen little improvement and by the next morning, I found myself still in AFIB. I suspect that as a card-carrying member of Mensa, if I tested now I would assuredly be denied membership. I decided that perhaps the catalyst of a gentle 45-mile bike ride would restore my normal heart rhythm. As I pedaled out of my driveway, I encountered a neighbor who waved me over and as he was congratulating me for winning my latest state championships, I glanced down at my heart rate monitor noticing much to my dismay that I was pumping along at 154 beats per minute even though I was standing still. Being the incredibly intelligent guy that I am, I continued on my bike ride, and continued to justify that action to myself when I noticed that when I pedaled, my heart rate would come back to a mere 144 beats per minute. Even more encouraging was that when I really mashed down on the pedals, my rate came down into the 130s.

As I rode along, I apparently began thinking a bit more clearly when I decided to stop my ride after a paltry 35 miles. Although I fought against the concept, my significant other forced the issue insisting that we go to the Largo Medical Center, a place renowned for their cardiac unit.

In the ER, a team of about 6 personnel swarmed me when a monitor revealed not only my very rapid heart rate, but also showing substantial arrhythmia. Rather than the outcome I assumed—get some drugs and go home– the ER physician insisted that I be admitted to the hospital’s cardiac unit. There I discovered that my heart rate was not the 150 beats per minute that I was assuming – a heart rate monitor displays the beats per minute of the ventricles, but my atria were racing along at an incredible 300 beats per minute and in a very arrhythmic manner. My body was infused with various medications through an IV including blood thinners and calcium channel blockers, and the cardiologist scheduled me for two procedures the next day, both of which would require general anesthesia.

When the atrium is beating with great rapidity as was mine, the blood tends to pool in the atrium leading to potential strokes and or heart attack caused by blood clots. My first procedure would be a so-called TEE procedure – a trans esophageal echocardiogram. A tube is placed down the patient’s throat bringing a transmitting device close to the heart with the mission of determining if there were any clots waiting to do their potentially catastrophic damage. If the answer was “yes”, it called for one tack and if the answer was “no”, then an ablation procedure would be scheduled the same day administered by a cardio electrophysiologist whose specialty was dealing with arrhythmias of the heart through various interventional procedures.

Rosie, my significant other, calls me Dr. Scott, because, as someone who intended to go to medical school from the age of 3, I am always studying medical literature – I find it quite fascinating. I had self-diagnosed myself with AFIB, but the “real” doctors disagreed with my diagnosis – I was suffering from atrial flutter. With atrial flutter, the right atrium sets up a circular pattern of electric impulses causing confusion of the signal to the left atrium. The result is a rapid, arrhythmic, potentially fatal heartbeat.

The procedure used to restore the normal electrical impulses is called an ablation in which incisions are made on either side of the groin and catheters are run up through either arteries and/or veins to the heart. The patient undergoes a diagnostic procedure using a fluoroscopic X-ray device, which can map out the impulses in the heart such that the electrophysiologist can determine what part of the atria the offending signal is emanating from. The cardiologist then uses RF energy to zap the offending heart tissue, in effect destroying it such that it can no longer send erroneous signals. But I digress.

Fortunately, it was discovered that I had not managed to generate any blood clots, although I certainly went through some very efficient means to do so while riding with atrial flutter! The next afternoon, I underwent general anesthesia for the second time within a very few hours and the wizard, Dr. Norris, was able to successfully zap the offending heart tissue leading me to be rolled out of the operating room with a beautiful EKG pattern with my heart beating at a normal rate. Of course I was kicking and screaming through everything insisting that in under three weeks, the most important cycling competition event of the year was looming – the USCF, Florida state time trial championships where I hope to win the title for the 7th year in a row. I didn’t have time for this stuff – I had to get out on the road and train!

I finally escaped from the hospital after 4 long days of incarceration; I am on blood thinners and have surgical wounds that must be taken into account. I still hope there is a way I can make it to the line at the state championships on October 13th.

Any lessons here? I think the reader can glean a few, but those of you who are used to thinking of yourselves as super human, I have some bad news for you – we are all human, and I again maintain my thesis that elite aerobic athletes have very high odds of experiencing medical issues – especially heart related. I must have taken it a bit too seriously when my friend and teammate, Dr. George Sheehan, pronounced me as having one of two of the strongest, most athletic hearts he had ever seen in his rather long practice of cardiology. This has always made me feel particularly immune to heart disease and failure. It seemed to override the practical advise from my practical mate, Rosie, and my intellectual side in that the symptoms were taking me to a stroke or heart attack and not to a cycling podium (top step of course) finish.

Addendum – 7-29-14

I had occasion to re-read this article this morning and I realized that I never told the rest of the story. I did in fact go on to contest the Florida State Time Trial Championships two weeks after the above described procedure. I won for the 7th year in a row with a winning margin over the second place finisher of 2 minutes!

My original question regarding elite athletes has now been broadened to question excessive exercising in general. Having won national championships in two aerobic sports (running and cycling) and as one who prior to getting back to aerobic pursuits was a very active weight lifter, what is my recommendation regarding exercise?

If you are a competitive athlete, and want to remain competitive, you cannot ease back on your training. Know however, that you put yourself at considerable, statistical medical risk through those pursuits in my opinion. For the rest of us, realize that results rapidly diminish after about a half hour of vigorous aerobic training. My specific recommendations are these:

1) Do a vigorous form of aerobic exercise for 20-30 minutes a minimum of 4 times a week.

2) Incorporate interval training into your training sessions at least once per week. If you search my blog archives you will see information on interval training.

3) Incorporate weight training into your regimen – you need not work each muscle group any more than once a week for optimal results. If you search the archives of this blog, you will find two articles that I have written on the subject of weight training.

4) And very importantly, get at least annual medical checkups.

Be well and enjoy your training rather than be married to it!
Sandy Scott

pedalmasher@gmail.com

Learn About Mesothelioma

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LEARN ABOUT MESOTHELIOMA!

Every one of our lives is touched by cancer – I personally have had a serious malignant melanoma, my daughter is a breast cancer survivor, my mother died of pancreatic cancer and my grandfather died from prostate cancer. Most of us are rather familiar with the more common types of cancer, but one form of cancer that perhaps you might not be familiar with is Mesothelioma – a cancer caused by among other things, exposure to asbestos.

I recently met Cameron Von St. James, whose wife, Heather, is a survivor of this horrible disease.

Have you ever heard of Mesothelioma? Mesothelioma is an aggressive cancer, with no known cure, that affects the lining of the lungs and the abdomen. The most common cause for mesothelioma is exposure to asbestos. In most cases, people are misdiagnosed due to symptoms that are similar to other diseases but signs of mesothelioma start appearing around 20-50 years after exposure to asbestos. In 2005, Heather Von St. James was a victim of this horrible disease. Heather had been exposed to asbestos as a young girl from her father’s work clothes when he would come home covered in white dust. It wasn’t until 3 months after having her only child Lily that she started to notice symptoms. She would chalk these symptoms up to being a new mom but she knew something wasn’t right. Heather was diagnosed with malignant pleural mesothelioma in November 2006 and had a life saving surgery in February 2006 where she had her left lung removed. Every year around 3,000 people are diagnosed with mesothelioma. Heather feels it’s her duty as a cancer survivor to use her voice to spread awareness and mostly importantly hope to others who are facing a similar battle. So, how can you help? Do yourself a favor and take a moment for mesothelioma by visiting the Mesothelioma Cancer Alliance where you will learn more about the disease and how you can help.

If you are interested in learning more about the work of Cameron Von St. James, please visit Cameron Von St. James blog site.

Sandy Scott
pedalmasher@gmail.com

The Latest From The American Urological Association

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The Latest From The American Urological Association

When I was being treated for my broken neck in 2006, my board certified spine surgeon informed me that I was in grave danger unless I had my upper cervical spine fused. The operation was apparently so complicated that he admitted that he was not qualified to perform it, his status as a board certified spine surgeon notwithstanding. Through a considerable amount of research, I ferreted out a highly qualified surgeon who I had reason to believe might shepherd my recovery sans surgery. I’ll never forget when he said to me, “The only one who will benefit from you having spine surgery will be me – financially.” As an aside, unlike my previous physician, he was qualified to perform the procedure. I wish more urologists would learn and relate the aforementioned statement to their patients.

Some fascinating news has just come out as a result of the annual meeting of the American Urological Society. I have written about the phenomenon of over treatment for prostate cancer in this country – a situation that often relegates the patient to a diminished lifestyle for a “disease” that would have potentially had no negative affect on the patient in his lifetime. A large registry in Michigan that tracks prostate cancer treatment reports that only 50% of men with low-risk prostate cancer patients who would have been eligible for active surveillance actually, take that tack and undergo radical treatment often leading to serious negative side-effects. The good news is that since 3-4 years ago, the rate of men taking the active surveillance route has doubled so the word is getting out.

The father of active surveillance is Dr. Laurence Klotz, and he is the lead investigator of long-term study of over a thousand men on active surveillance. He reports that after 10 years of monitoring these men, only 3.6% developed metastatic disease, and 1.7% have died of prostate cancer. You might think even those are bad odds, but Dr. Klotz points out that these statistics are similar to the expected mortality in those patients that get treated by radiation or surgery. To me, I’ll take my chances with the same statistics and zero side effects should I ever be diagnosed and shown to have a qualifying Gleason score!

A Gleason score of 6 definitely gives a patient the choice to take the active surveillance path, put the question was addressed, “Can a Gleason score of 3 + 3 = 6 metastasize outside the prostate gland into the seminal vesicle?” The cases of 2500 patients were reviewed to make that determination and the study revealed that NOT ONE SINGLE CASE of seminal vesicle invasion was documented when the cancer was exclusively grade 6. Also, out of 173 men with a Gleason score of 6 who had lymph nodes removed, not a single case of lymph node spread was observed. After 5 years, not a single patient had developed metastases.

The use of Statins has become a bit controversial lately. I personally have taken them for years. In Finland, a study was undertaken evaluating 6000 men to determine the difference between those taking and those not taking statins. The study revealed that Statin use reduced prostate cancer mortality by two-thirds.

A study in Europe revealed that there was an overall 60% reduction in overall mortality in men with advanced cancer taking Statins versus those who were not. Cardiovascular mortality was found to have been reduced by a similar amount.

Let’s say that you choose the surgery route. Statistically, what do you gain? A study in Denmark estimated that the length of life gained with surgery compared to the general population was 0.4 years after 10 years of observation!

Unfortunately, most of the men who are biopsied for potential prostate cancer undergo a random biopsy which at best is a hit or miss proposition with both inaccurate positives AND negatives. How much better is an MRI guided biopsy?

One of the problems with the popular random biopsy method is that it finds too many low-grade level 6 cancers leading to too much unnecessary radical type treatments. A multiparametric MRI finds high-grade disease quite efficiently and tends to miss only small, low-grade tumors. If you do need a biopsy, consider taking this modern tack.

Things are progressing in the world of prostate cancer and I have watched the stock price for Intuitive Surgical Supply, the maker of the da Vinci robotic surgical device, decline over the last couple of years. Be an active, educated patient – no one cares more about your health than you!

Sandy Scott
Pedalmasher@gmail.com

You Have Been Diagnosed With Prostate Cancer – Now What?

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You Have Been Diagnosed With Prostate Cancer – Now What?

I have written about the subject of prostate cancer in the past. Two of my previous blogs deal with the subjects of prostate cancer in general and the controversy surrounding PSA testing. The two articles can be found here:

http://sandyscott.growingbolder.com/the-controversy-of-psa-testing-for-prostate-cancer-screening/

https://growingbolder.com/blogs/health/men/prostate-diaries-837229.html

Let’s assume that you have been diagnosed with prostate cancer. According to the American Cancer Society, 233,000 men will be diagnosed with the disease in 2014 and statistically, one in seven men will be diagnosed during their lives. I think it is important to know that there is a new model of treatment thankfully, but slowly emerging. In the past, the tendency was to concentrate on the tumor with the tendency to rush to radical (oftentimes unneeded) treatment frequently in the form of a radical prostatectomy. The result was a high percentage of men left to deal with negative, often life altering side-effects the result of a treatment for a disease that in many cases would have had no effect on the patient’s longevity had they not been treated.

One example that comes to mind is a friend of mine who upon being diagnosed with prostate cancer took the attitude, “I want this out of my body,” and underwent an immediate radical prostatectomy. He now describes his sex life as “trying to make love with a rope.” So many patients simply took the advice of their urologist/surgeon and hoping for the best, went ahead with a radical treatment that may or may not have been needed. It has been recently shown that a very high percentage of men who underwent radical prostatectomies would have remained asymptomatic throughout their lives with no treatment, but in many cases are now living with disturbing side effects of the surgery.

The emerging model promotes you, the patient, to the job of Captain of your fate and how you deal with your disease. Although some forms of prostate cancer are quite aggressive leaving only the choice of what type of treatment to have, a high percentage of the cancers are very slow growing, non-aggressive types that will not become symptomatic in the patient’s life time. You must do the thorough research and ferret out every possible choice. There is no rush to make a decision. My personal suggestion is to engage the services of a urological oncologist. Understandably, if your urologist is a surgeon, the tendency will be to guide you to the treatment he knows and trusts – surgery. There will undoubtedly be no effort to ascertain the underlying cause of your issues. A urological oncologist has no horse in the race and will guide you in an unbiased manner towards the best tack for you. Unfortunately, there are only about 100 such practitioners in the country. As an aside, always get a second or even third opinion.

Speaking with survivors of prostate cancer, there are some common threads. It apparently is quite empowering to take charge of your own health and well being focusing on nutrition, exercise, attitude and surrounding yourself with the support of friends and family. The latter concept seems to be much easier for women than it is for us men, but it is an extremely important aspect of heeling. In the new model of prostate cancer, the importance of psychological and emotional stability is becoming more and more apparent. A sense of optimism and hope seems to strengthen the immune system.

You will find that being in charge of your life and your health will become a lynchpin in the overall healing process.

Finally, the happiest cancer patient I know is a friend diagnosed some years ago. He took charge of his life, made the decision to change his lifestyle including a regular regimen of exercise and the incorporation of good nutritional habits. He engaged in a new, exciting personal relationship. He took the tack of active surveillance, which includes the lifestyle changes and regular medical/urological checkups. He is happy, healthy and is living with no symptoms or negative side effects.

Remember that some physicians are now recommending that many forms of prostate cancer be considered a chronic condition rather than having the label of “cancer” applied to the disease. Take charge and may the force be with you!

Sandy Scott
pedalmasher@gmail.com